Dr. Philp McMillan,  John McMillan

Editor’s Note: This article discusses emerging research on potential long-term health effects following COVID-19 infection and vaccination. The information presented is based on peer-reviewed studies but represents an evolving area of science. Readers should consult healthcare providers for personal medical decisions.

A physician examining a patient with lung cancer noticed something peculiar. After the standard examination, he began asking seemingly bizarre questions. Had her handwriting changed? Was she wearing an extra pair of socks with her open-toed shoes? When was the last time she’d gone out with friends? Later, he explained his method: “A woman doesn’t know what to say if you ask her if she has neuropathy, but no one can forget putting on an extra pair of socks.”

This physician’s approach—seeking indirect evidence of underlying problems—mirrors a larger challenge in modern medicine. Doctors worldwide are encountering patients whose health seems to be quietly deteriorating months or even years after COVID-19 infection or vaccination. These patients often appear normal on standard tests, yet they describe feeling perpetually unwell—a phenomenon that new research is beginning to explain.

The Five Stages No One Talks About

What makes this situation particularly concerning is how deterioration can unfold through distinct stages spanning months or years. Understanding these stages might enable earlier intervention. However, it’s important to note that not everyone progresses through all stages, and many people recover completely without long-term effects.

Stage 1: The Walking Tired

Sarah, a 45-year-old teacher, exemplifies the first stage. She looks healthy, maintains her schedule, but feels constantly drained. “I’m always fighting something off,” she tells friends. Her blood work comes back normal, yet she knows something’s wrong.

At this stage, viral particles or proteins may continue circulating, slowly affecting blood vessels in crucial organs. The immune system’s interferon response—those early-warning signals that fight both viruses and cancer—may be dampened. People function, but they’re running on reserve power.

Stage 2: When the Body Rebels

Then come unpredictable flare-ups. One day it’s a rash, the next joint pain, then heart palpitations that send Sarah to the ER only to be told “everything looks fine.” This isn’t hypochondria—it’s immune dysregulation.

The gut’s bacterial ecosystem, normally a careful balance, becomes disrupted. Italian researchers found that beneficial bacteria like Bifidobacterium completely disappeared in some patients, while harmful Clostridia increased sevenfold. These pathogenic bacteria produce toxins that can leak into the bloodstream, potentially triggering seemingly random symptoms.

Multiple studies indicate that women and younger people with allergies seem particularly vulnerable to this stage, though the mechanisms remain under investigation.

Stage 3: The Smoldering Fire

As immune dysregulation progresses, the symptoms consolidate into a more persistent pattern. By stage three, hiding illness becomes impossible. Dark circles ring Sarah’s eyes. Simple tasks require careful energy budgeting. Brain fog descends, making once-easy mental tasks feel insurmountable.

Inside the body, a complex inflammatory cycle may develop. Immune cells called macrophages and mast cells can create feedback loops: macrophages activate mast cells, which release histamine, which activates more macrophages. This process may contribute to micro-clot formation, potentially reducing oxygen delivery to tissues.

Stage 4: The Wasting

In this stage, muscle mass diminishes rapidly—not the gradual softening of sedentary life, but an active breakdown of muscle tissue. These patients eat, yet lose weight. They rest, yet weaken.

“They just look unwell,” physicians report with a helplessness that medical school never prepared them for. “They have no energy. And you oftentimes can’t do anything to help them.” Blood tests might hover near normal, but the clinical picture tells another story.

A peculiar pattern emerges: repeated infections with minimal symptoms. No fever, no dramatic presentation. Just quiet pneumonia discovered incidentally, treated, resolved, only to return weeks later. Sarah, who once rarely missed work, now cycles through antibiotics monthly.

Stage 5: The Final Collapse

The end comes not with a bang but with a whisper. Multiple organ systems begin synchronized shutdown: liver enzymes creeping upward, kidney filtration dropping, the heart struggling. It resembles sepsis, yet blood cultures return negative.

Sarah’s final admission brought shortness of breath, lungs filling with fluid, advancing kidney failure. Physicians deployed everything: antivirals, steroids, immune modulators. Brief improvements offered false hope before inevitable decline. Fourteen months elapsed from first infection to death—fourteen months of slow-motion catastrophe.

The virus doesn’t kill cells directly as Ebola would. Instead, it masters systems disruption, turning the body’s maintenance mechanisms against itself.

Ripple Effects

As immune systems become compromised, we risk creating conditions for reactivation of latent infections. Tuberculosis, dormant in approximately one-third of the global population according to WHO estimates, could reactivate when immune surveillance fails. Fungal infections and dormant viruses—herpes, Epstein-Barr, cytomegalovirus—may also resurge.

However, we need to maintain perspective: while these risks exist, they affect a minority of individuals, and most people maintain effective immune function even after multiple exposures to virus or vaccine. Some people stabilize at Stage 2 and never advance. Others recover function thought permanently lost. The key appears to be early recognition and intervention at each stage.

The Path Forward

“We could have known. We could have asked, could have looked,” reflects one researcher. The statement carries both regret and urgency.

For individuals, it means respecting subtle symptoms. That persistent fatigue may not be just aging. Those recurring infections could be something other than mere bad luck. The weird rashes, joint pain, brain fog—these might be warning signals of a still-addressable process.

Medicine must rethink post-COVID illness not as the binary sick-or-recovered framework that Western medicine typically employs, but as a spectrum of dysfunction that can progress over years. For society, this means acknowledging our interconnectedness in ways previously unimagined. The immunocompromised may become reservoirs for reactivated infections that can spread to the broader population.

Understanding these mechanisms brings into focus an unprecedented virus capable of triggering chronic illness and years-long decline. The path forward requires humility in acknowledging our incomplete knowledge and recognizing that solving one problem may have created others. Most importantly, it requires listening to the millions whose bodies are telling us something is terribly wrong, even when their tests appear normal.

Like that observant physician who asked about extra socks rather than neuropathy, perhaps we need to look for the subtle, indirect signs of a process that standard medicine isn’t yet equipped to measure. The body keeps meticulous records of every insult, every intervention. Those records are now being revealed in the exhausted faces of patients, in climbing cancer statistics, in the quiet reactivation of diseases we thought conquered. The question isn’t whether we’ll read these records, but whether we’ll read them in time to change course.

References

Japanese Cohort Study (2023): “Five doses of the mRNA vaccination potentially suppress ancestral-strain stimulated SARS-CoV2-specific cellular immunity”

Repeated COVID-19 mRNA vaccination results in IgG4 class switching and decreased NK cell activation by S1-specific antibodies in older adults

Increased Age-Adjusted Cancer Mortality After the Third mRNA-Lipid Nanoparticle Vaccine Dose During the COVID-19 Pandemic in Japan